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Strong Medicine

Strong Medicine

There are 13 of them in the work-out room this morning, and they are hard at it. It's nine a.m. and, although nary a boom-box is blasting, the cobwebs have long since been swept away.

Men and women together, they run through the program with business-like intensity. Leg extensions. Shoulder shrugs. Bicep curls. Many in this group have been lifting weights together for three years, so there's no messing around. Well, maybe a little bit.

"These heavy ones are killing me!" Harriet says, feigning exhaustion.

Somebody else likens the sounds produced by a set of neck rolls to the crunch and rattle of a coffee grinder.

But Clyde Doll, their trainer, a national-champion power lifter, keeps things moving along.

He sits in the middle of the room, or prowls the floor, coaxing, teaching, gently prodding. "Get those elbows in, Mary, that's better." "Looking good today, George." After each set, he calls the roll, recording repetitions. They sing out their numbers, and he notes each one on a canary-colored chart.

Seconds after the last exercise, the lifters cut out en masse, eager to get on with the rest of the day. Before you can turn around they've scattered, most of them quickly disappearing behind their apartment doors.

Doll, left to gather the dumbbells, glows with pride when he talks about his pupils. "They have to want to do it," he says. "But when I see them trying their hearts out . . ." He shakes his head admiringly.

At 60, Doll is an imposing figure: Bull-necked and barrel-chested, with big meaty hands that are always flexing, eager to grip iron. His wavy silver hair, however, wins him no respect from his charges: They are residents of Brookline Retirement Village in State College, Pennsylvania, and old enough, one and all, to be his parents.

Violet and Mary are both 94. Naomi is 91. Harry, the frisky kid of the bunch, is 89.

Oh, and there's Ethel, another 94-year-old. She couldn't make it to class today. She had to get downtown early to open up her store.

The fountain of youth turns out to be damnably unglamorous.

It's weightlifting, for Pete's sake. Pumping iron. Listen to what Penn State nutritionist Wayne Campbell has to say about the results of a recent trial:

"If this were a pill, it would be a miracle drug."

Or physiologist Bill Evans:

"No other single intervention holds greater promise of keeping people out of nursing homes."

Whatever happened to rocking chairs? What about taking it easy? Forget it. Campbell has a new concept for senior citizens: Cross-training. Old age, to paraphrase the title of a popular book, is not for sissies anymore.

Evans, director of Penn State's Noll Lab, and Campbell, a research associate at the lab, are in the vanguard of a group of researchers who are beginning to rethink what it means to grow old. Their studies of the physiological effects of exercise not only point the way to increased health and vigor in the later years—extended youthfulness, if not extended youth—they also challenge long-held assumptions about the aging body: its capabilities and its limitations.

Fact: As we age, the composition of our bodies undergoes a fundamental change. Simply put, between age 20 and 70 we lose some 30 percent of our muscle. What muscle remains tends to become atrophied: it shrinks. And then we get fat. From 20 to 60, the average woman's body-fat percentage jumps from 23 to a hefty 44; the average man's from 18 to 38. Altogether, this transformation has numerous nasty consequences for our health.

Myth: There is nothing we can do about it.

"Much of what we call aging," Evans explains, "is the accumulation of a lifetime of inactivity and poor nutrition."

As we age, we tend to stop exercising. We may also stop getting enough protein in our diet. We lose muscle, or lean body mass. Since lean body mass requires considerably more energy than fat to maintain itself, losing it means a drop in our resting metabolic rate, the amount of energy we burn to keep our bodies functioning. In short, we need fewer calories. The problem is, says Evans, most of us don't make the called-for adjustment in what we eat, and those surplus calories take up residence in our bodies—as fat.

Depressing, isn't it? But Evans, Campbell, and others have shown that this metamorphosis can be slowed, in some respects stopped—even reversed. Not by eating right, as important as good nutrition is to wellness. Not by running or cycling or swimming laps in a pool, as crucial as aerobic exercise is for the upkeep of the old ticker. By lifting weights.

Call it strength training, resistance training, whatever you want: pumping iron can produce dramatic results in the elderly (and not so elderly) population.

In one widely reported study conducted at Tufts University, where both Evans and Campbell worked before coming to Penn State, Campbell took 12 people ages 56 to 80 and put them through 12 weeks of workouts. They did bench presses, lat pull-downs, leg curls, and leg extensions three times a week. Over this short time, Campbell measured sizeable improvements.

Muscle strength, for one thing, jumped by anywhere from 24 to 92 percent. Men in their 70s were able to go from being able to lift 44 pounds to hoisting 85 pounds.

Even more importantly, however, strength training boosted the subjects' resting metabolic rates. Subjects were fed a carefully regulated diet, adjusted as the experiment progressed in order to maintain their starting body weight. By the end of the training Campbell found that subjects were requiring 15 percent more calories just to keep their weight steady. In other words, an older person used to consuming 2,000 calories a day now needed 2,300 calories in order not to lose weight.

And this: Each subject lost an average of four pounds of body fat.

Powerful results, for several reasons. First, they suggest that strength training can be a valuable part of a weight-loss program, that weight-lifting burns calories at least as effectively as aerobic exercise does.

Second, being able to eat more without gaining weight is important for reasons beyond pleasure. Getting enough nutrients can be a problem for elderly people. Says Evans, "Generally older people need fewer calories, but because of this they can be deficient in some aspects of diet, like protein requirements. They have to be more careful about nutrient densities. They have to watch high-fat foods." But if they can eat more (and still eat wisely) they are more likely to get what they need.

Lastly, less body fat means lower risk of heart disease, atherosclerosis, and diabetes. "Mature-onset diabetes," says Evans, "is less related to advanced age than to an increase in body fat, especially accumulation of fat in the upper body. It can be prevented by exercise. Even once people get it, aggressive intervention—exercise and weight loss—can prevent further development of the disease."

Most everybody recognizes that too much fat is no good for us. But the loss of muscle that precedes our fattening up, Evans argues, is a serious condition in itself. He has even coined a term for it, in hopes of boosting clinical recognition of the problem: Sarcopenia, from the Greek for "flesh reduction." On average, from early middle-age we tend to shuffle off six to seven pounds of muscle every decade. Aerobic exercise alone cannot prevent this loss. "Running, biking, and swimming are very good for cardiovascular fitness and flexibility," says Campbell, "but they won't build muscle tissue."

When we lose muscle, we lose strength, at a rate Evans estimates at about one percent per year. Eventually, those one percents add up. The Framingham study, a well-known longitudinal study completed in Massachusetts in 19xx, showed that half of women ages 55-65 and 70 percent of those 75 to 85 couldn't lift ten pounds. This figure can be easily translated to the tasks of daily living: if you can't lift 10 pounds, how can you haul groceries, lift laundry, or hoist your grandchildren?

Muscle weakness can lead to more serious problems too: frailty, functional decline, immobility, and falls, which are the number one cause of accidental death and injury in the elderly.

And again, it's a problem that could be largely prevented. "Here we have a growing disability, a lack of independence," Evans says, "that is not due to cognitive problems or disease but to profound inactivity."

Use it or lose it. Simple as that. But why don't we use it? Here we venture back into myth. Received wisdom—and earlier research—holds that old muscles just don't work, they don't respond: like old rubber bands they're flat, spent, pooped. Old people don't exercise because they can't; their withered muscles won't allow it. More likely, says Evans, it's the other way around: they can't exercise because they don't.

"Our research shows that muscles will get stronger in response to strength training no matter what your age."

The key seems to be intensity. Earlier studies of weight training in elderly populations, Evans says, had been limited to low-intensity exercise: non-taxing workouts with very light weights. Not surprisingly, he adds, they didn't achieve much in the way of results. Evans and others, having worked extensively with top-grade athletes, knew that real improvement comes from high-intensity training. High intensity, Evans stresses, doesn't mean busting a gut. It does mean working up a sweat. "We define it as working with weights that are above 70 percent of your maximum lifting capacity." Such weights had never been systematically tried with older people.

Many clinicians, Evans acknowledges, have stayed away from recommending strength training for their elderly patients because of concerns about raising blood pressure, or putting stress on the heart. What he has found, however, is that while aerobic exercise causes a substantial rise in systolic blood pressure, strength training, with proper technique, does not. Evans and his co-workers teach their subjects to breathe properly while lifting, and to keep their movements slow and smooth. They emphasize that anyone embarking on a strength-training program should get a medical checkup beforehand.

Given these preliminaries, and barring any serious pre-existing problem, Evans says that high-intensity strength training need not be limited to a chosen few. He cites a 1991 study, in which ten 90-year-old nursing-home residents tripled their strength after eight weeks of resistance training, and a recent follow-up involving 100 frail nursing-home residents, people with a mean age of 87, who in ten weeks showed a doubling of strength and across-the-board improvement in functional measures like walking speed, stair-climbing power, and balance. All with no untoward effects.

"If it can work in this population," Evans says, "it's appropriate for anybody."

Evans and Campbell have attracted lots of attention in the national media with their work. Both have been cited in the New York Times, the Washington Post, and other national publications, as well as in countless health and fitness magazines. Evans' work has appeared on Good Morning America, 20/20, and CBS This Morning. In 1991, Evans, along with Irwin Rosenberg, director of the Tufts Center, wrote a popularly styled book, Biomarkers: The 10 Determinants of Aging You Can Control.

Aging, Evans acknowledges, "is a growth industry."

Among researchers, too, he says, "There's a lot of interest, because there's a great potential payoff. Great changes can be achieved. There are a lot of things we can do to keep people healthier and independent."

That interest is reflected in the changing focus of Penn State's Noll Lab, a facility long known for its research into chiefly athletic performance.

Currently, Noll is home to eight faculty researchers, several of whom are doing work in physiological aspects of aging. Assistant professor Joe Cannon, who followed Evans from Tufts, is looking at age-related changes in immune function. Larry Kenney, a physiologist, has studied how aging affects the body's temperature regulation, important for understanding what makes older people, for instance, more susceptible to summer heat waves. Evans and Campbell have investigated the effects of strength training on bone loss in post-menopausal women.

Evans, who says he was first drawn to Noll by its unique environmental testing facilities, has collaborated with C. McCollister Evarts, chief executive of Penn State's Hershey Medical Center, to win NIH funding to establish a clinical research center on the lab's top floor.

"We'll have an area upstairs where subjects can live, and we'll be accredited just like a hospital," he says. "We'll have nurses and technicians—all the support necessary for controlled metabolic studies."

He predicts increased collaboration with researchers at Hershey, and with others at University Park. "This will be a resource for everyone."

Finally, Evans says he hopes to establish strong ties in the surrounding community, working with local agencies to find ways to translate the lab's research into an improved quality of life for the older-adult population.

This last is a priority. "If what we do has no practical application," Evans says, "it's hardly worth the effort."

Wayne Campbell is not shy in estimating the potential rejuvenating power of strength-training. "We can wipe out 30 to 40 years of sedentary living in 12 weeks," he says.

The bad news: In order to maintain that improvement, you have to keep on hitting the weights.

"The $64,000 question is how to get people to sustain their efforts," Campbell says. "The data on drop-out rates and lack of adherence is pretty depressing."

Even with diligence, there are limits to what can be achieved. For one thing, a certain amount of muscle loss is inevitable: We lose a significant percentage of our actual muscle cells as we age.

But other changes may simply reflect that we're not responding to—or even aware of—the body's changing needs. One of the more important findings of Campbell's Tufts study is that older people require more protein in their diets than was previously thought. The current Recommended Daily Allowance, 0.8 grams per kilogram of body weight, "is basically an extrapolation of measurements done from young men." Campbell suggests that 1.0 gram would be more like it. Older people who eat less than this may be at risk for protein deficiency, which contributes to muscle loss.

It's best to start counteracting the aging process early, Evans says. That's when intervention will do the most good. "Strength training can hold off the body composition changes that occur primarily between the ages of 35 and 55."

And, says William Kraemer, a colleague who has interacted with Evans since Tufts days and now director of research for Penn State's Center for Sports Medicine, it's important to realize that some kinds of strength are more important to the older population than others.

Kraemer, who has designed training programs for Olympic athletes, draws a distinction between raw strength and power.

Strength, he says, is force exerted at slow speed. Power is the ability to summon force quickly. "Power is more important in daily life." If you slip on ice while carrying a bag of groceries, it is a surge of power that allows you to shift and keep your feet. If you lose your balance on the bus, you need power to grab the handrail and hold yourself up.

In order to develop power, Kraemer says, a muscle needs "explosive" training. But will this kind of training work for older muscles?

Using a computerized apparatus designed by Robert Newton, an Australian exercise scientist who is now at Penn State, Kraemer and Evans put ten 60-year-old men through an intense ten-week program doing weighted jump squats: half-squatting, with weight across their shoulders, and then seeing how high they could jump. (The apparatus took the weight off the men as they were coming down, to prevent jarring.)

When he compared his older squatters' results with those of a group of 30-year-olds, something interesting turned up. Both old and young lifters increased their strength—by about equal percentages. The young lifters also increased their power, similarly with light, medium, and heavy loads. But the older lifters, although they gained power with medium and heavy loads, showed no increase at all when they were carrying lighter weights—the loads most applicable to real-life situations.

Kraemer is currently scratching his head at this discrepancy. Is light-load power a capability that is lost irretrievably by age 60? "Maybe it just requires a longer training period to develop it," he suggests. "Or maybe when we look at the nervous system we'll find that older people can't activate their muscles as quickly."

Aging, he suspects, "is a matter of interacting factors of downward causation. One thing slips a little and that has a negative effect on the next thing. It's a matter of holding the line.

"And it seems like muscle mass and the neuromuscular system are where a lot of the action is. Other things get involved, of course—the immune system, hormones, nutrition—but the easiest thing we can do is get stronger."

Clyde Doll tells a story about how Violet, at 94 one of the stalwarts of his strength-training class at Brookline Village, came to join the program.

"She passed by one day about a year ago and stopped in the doorway," Doll remembers. "The next day she poked her head in. 'I cant come in here,' she said, 'I've got arthritis.' I said: 'You're not allowed to come in here unless you've got arthritis.'"

Ingrained perceptions, Doll says, are a major impediment to older people becoming active. "They think 'I can't do that,' because that's what they've been told."

"One thing that would help is some realistic role models," Campbell says. "Not everybody has to run marathons or be able to dunk a basketball. The important thing is to get out and do something. If we can just get people to the next level of activity—the couch potatoes to be marginally active, the marginally active to be active—then we can have a profound effect on health outlook and disease prevention."

Doll starts his charges out by having them lift cans of soup. They work their way up to two-, four-, and 10-pound dumbbells.

"Anything you can do to make them the least bit more independent, they're so appreciative," Doll says. One of his younger students, a woman of 72, called him recently to announce that she had opened a jar of pickles—for the first time in years. Naomi, 91, who uses a walker to get around and does most of her workout sitting down, has regained enough strength to hang clothes in her closet. Many students report being less bothered by the stiffness and pain of arthritis.

Then there's the 93-year-old woman who completed the strength program in the Tufts study. Her verdict?

"I feel as if I were 50 again."

William J. Evans, Ph.D., is professor of nutrition and exercise and sport science and director of the Noll Laboratory for Human Performance Research, 119 Noll Lab, University Park, PA 16802; 814-865-3453. Wayne Campbell, Ph.D., is a research associate at Noll. William J. Kraemer, Ph.D., is associate professor of applied physiology in the department of exercise and sport science and research director of the Center for Sports Medicine, 146 Recreation Building, University Park, 865-7107.